About us Contacts Drug interactions: 390 212
Drug search by name

Cardizem Intravenous and Inderal

Determining the interaction of Cardizem Intravenous and Inderal and the possibility of their joint administration.

Check result:
Cardizem Intravenous <> Inderal
Relevance: 08.11.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using propranolol and dilTIAZem together may lead to increased side effects. This can cause fatigue, headache, fainting, swelling of the extremities, weight gain, shortness of breath, chest pain, increased or decreased heartbeat, or irregular heartbeat. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment or need your blood pressure checked more often to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR CLOSELY: Additive reductions in heart rate, cardiac conduction, and cardiac contractility may occur when calcium channel blockers, especially verapamil and diltiazem, are used concomitantly with beta blockers. While this combination may be useful and effective in some situations, potentially serious cardiovascular adverse effects such as congestive heart failure, severe hypotension, and/or exacerbation of angina may occur. Ventricular asystole, sinus arrest, and heart block have also been reported. The risk is increased with high dosages, IV administration, left ventricular dysfunction, or AV conduction abnormalities. Beta blocker ophthalmic solutions may also interact, as they are systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels. Bradycardia (36 bpm) with wandering atrial pacemaker occurred in a patient taking oral verapamil and timolol ophthalmic drops. The proposed mechanisms include additive slowing in AV conduction, reduced cardiac contractility secondary to beta-blockade, and decreased peripheral vascular resistance secondary to calcium channel blockade. In addition, verapamil and diltiazem may decrease the clearance of some beta blockers and use of diltiazem with beta blockers has been associated with an increased risk of depression.

MANAGEMENT: Close clinical monitoring of patient hemodynamic response and tolerance is recommended if these agents are used together, and the dosage of one or both agents adjusted as necessary. Patients should be advised to promptly report any symptoms including fatigue, headache, fainting, swelling of the extremities, weight gain, shortness of breath, chest pain, increased or decreased heartbeat, or irregular heartbeat.

References
  • Packer M "Combined beta-adrenergic and calcium-entry blockage in angina pectoris." N Engl J Med 320 (1989): 709-18
  • Nievel JG, Havard CW, Douglas-Jones AP "Comparison of concomitant nicardipine hydrochloride and propranolol with propranolol alone in patients with essential hypertension." Eur J Clin Pharmacol 33 (1987): 21-5
  • Carruthers SG, Freeman DJ, Bailey DG "Synergistic adverse hemodynamic interaction between oral verapamil and propranolol." Clin Pharmacol Ther 46 (1989): 469-77
  • Strauss WE, Parisi AF "Combines use of calcium-channel and beta-adrenergic blockers for the treatment of chronic stable angina." Ann Intern Med 109 (1988): 570-81
  • Keech AC, Harper RW, Harrison PM, et al "Extent and pharmacokinetic mechanisms of oral atenolol-verapamil interaction in man." Eur J Clin Pharmacol 35 (1988): 363-6
  • Rocha P, Guerret M, David D, Marchand X, Kahn JC "Kinetics and hemodynamic effects of intravenous nicardipine modified by previous propranolol oral treatment." Cardiovasc Drugs Ther 4 (1990): 1525-32
  • Zatuchni J "Bradycardia and hypotension after propranolol HCI and verapamil." Heart Lung 14 (1985): 94-5
  • Keech AC, Harper RW, Harrison PM, Pitt A, McLean AJ "Extent and pharmacokinetic mechanisms of oral atenolol-verapamil interaction in man." Eur J Clin Pharmacol 35 (1988): 363-6
  • Winniford MD, Fulton KL, Hillis LD "Symptomatic sinus bradycardia during concomitant propranolol-verapamil administration." Am Heart J 110 (1985): 498
  • McLean AJ, Knight R, Harrison PM, Harper RW "Clearance-based oral drug interaction between verapamil and metoprolol and comparison with atenolol." Am J Cardiol 55 (1985): 1628-9
  • Wayne VS, Harper RW, Laufer E, et al "Adverse interaction between beta-adrenergic blocking drugs and verapamil: report of three cases." Aust N Z J Med 12 (1982): 285-9
  • Eisenberg JN, Oakley GD "Probable adverse interaction between oral metoprolol and verapamil." Postgrad Med J 60 (1984): 705-6
  • "Product Information. Covera-HS (verapamil)." Searle, Skokie, IL.
  • Sinclair NI, Benzie JL "Timolol eye drops and verapamil: a dangerous combination." Med J Aust 1 (1983): 548
  • Sagie A, Strasberg B, Kusnieck J, Sclarovsky S "Symptomatic bradycardia induced by the combination of oral diltiazem and beta blockers." Clin Cardiol 14 (1991): 314-6
  • Misra M, Thakur R, Bhandari K "Sinus arrest caused by atenolol-verapamil combination." Clin Cardiol 10 (1987): 365-7
  • McCourty JC, Silas JH, Tucker GT, Lennard MS "The effect of combined therapy on the pharmacokinetics and pharmacodynamics of verapamil and propranolol in patients with angina pectoris." Br J Clin Pharmacol 25 (1988): 349-57
  • Leon MB, Rosing DR, Bonow RO, Epstein SE "Combination therapy with calcium-channel blockers and beta blockers for chronic stable angina pectoris." Am J Cardiol 55 (1985): b69-80
  • Bailey DG, Carruthers SG "Interaction between oral verapamil and beta-blockers during submaximal exercise: relevance of ancillary properties." Clin Pharmacol Ther 49 (1991): 370-6
  • Pieper JA, Miller JH "Serum protein binding interactions between propranolol and calcium channel blockers." Drug Intell Clin Pharm 18 (1984): 492
  • Hunt BA, Bottorff MB, Herring VL, Self Th, Lalonde RL "Effects of calcium channel blockers on the pharmacokinetics of propranolol stereoisomers." Clin Pharmacol Ther 47 (1990): 584-91
  • Bleske BE, Welage LS, Touchette MA, Edwards DJ, Rodman DP, Shea MJ "Evaluation of dosage-release formulations on inhibition of drug clearance - effect of sustained-release and immediate-release verapamil on propranolol pharmacokinetic parameters." Ther Drug Monit 16 (1994): 216-20
  • Schoors DF, Vercruysse I, Musch G, Massart DL, Dupont AG "Influence of nicardipine on the pharmacokinetics and pharmacodynamics of propranolol in healthy volunteers." Br J Clin Pharmacol 29 (1990): 497-501
  • Pouleur H, Etienne J, Van Mechelen H, et al "Effects of nicardipine or nifedipine added to propranolol in patients with coronary artery disease." Postgrad Med J 60 (1984): 23-8
  • Levine MA, Ogilvie RI, Leenen FH "Pharmacokinetic and pharmacodynamic interactions between nisoldipine and propranolol." Clin Pharmacol Ther 43 (1988): 39-48
  • McTavish D, Sorkin EM "Verapamil: an updated review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in hypertension." Drugs 38 (1989): 19-76
  • "Product Information. Toprol-XL (metoprolol)" Astra-Zeneca Pharmaceuticals, Wilmington, DE.
  • Ronn O, Bengtsson B, Edgar B, Raner S "Acute haemodynamic effects of felodipine and verapamil in man, singly and with metoprolol." Drugs 29 (1985): 16-25
  • Reddy PS, Uretsky BF, Steinfeld M "The hemodynamic effects of intravenous verapamil in patients on chronic propranolol therapy." Am Heart J 107 (1984): 97-101
  • Anastassiades CJ "Nifedipine and beta-blocker drugs." Br Med J 281 (1980): 1251-2
  • McCourty JC, Silas JH, Tucker GT, Lennard MS "The effect of combined therapy on the pharmacokinetics and pharmacodynamics of verapamil and propranolol in patients with angina pectoris." Br J Clin Pharmacol 25 (1988): 349-57
  • Pringle SD, MacEwen CJ "Severe bradycardia due to interaction of timolol eye drops and verapamil." Br Med J 294 (1987): 155-6
  • Murdoch DL, Thomson GD, Thompson GG, et al "Evaluation of potential pharmacodynamic and pharmacokinetic interactions between verapamil and propranolol in normal subjects." Br J Clin Pharmacol 31 (1991): 323-32
  • Keech AC, Harper RW, Harrison PM, Pitt A, McLean AJ "Extent and pharmacokinetic mechanisms of oral atenolol-verapamil interaction in man." Eur J Clin Pharmacol 35 (1988): 363-6
  • Henry M, Kay MM, Viccellio P "Cardiogenic shock associated with calcium-channel and beta blockers: reversal with intravenous calcium chloride." Am J Emerg Med 3 (1985): 334-6
  • Minish T, Herd A "Symptomatic bradycardia secondary to interaction between topical timolol maleate, verapamil, and flecainide: a case report." J Emerg Med 22 (2002): 247-9
  • Lee TH, Salomon DR, Rayment CM, Antman EM "Hypotension and sinus arrest with exercise-induced hyperkalemia and combined verapamil-propranolol therapy." Am J Med 80 (1986): 1203-4
  • Lee TH, Salomon DR, Rayment CM, Antman EM "Hypotension and sinus arrest with exercise-induced hyperkalemia and combined verapamil/propranolol therapy." Am J Med 80 (1986): 1203-4
Cardizem Intravenous

Generic Name: diltiazem

Brand name: Cardizem, Cartia XT, Dilacor XR, Dilt-CD, Diltia XT, Diltzac, Matzim LA, Taztia XT, Tiazac, Cardizem CD, Dilt-XR, Tiazac, Cardizem LA, Tiazac Extended Release Capsules

Synonyms: Cardizem

Inderal

Generic Name: propranolol

Brand name: Inderal LA, Inderal XL, InnoPran XL, Inderal, Hemangeol, InnoPran XL

Synonyms: n.a.

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

Interaction with food and lifestyle
Disease interaction